The document describes a research study on the effectiveness of psychodrama in treating panic disorder. It provides: 1) An overview of the study design which involved two psychodrama groups receiving psychodrama therapy plus pharmacotherapy and two control groups receiving only pharmacotherapy. Patients were evaluated before, after, and 6 months post-treatment. 2) Details on the 20 patients in each group who were well-matched at baseline. Measures used included the Hamilton Anxiety Scale to assess anxiety and the Spontaneity Assessment Inventory-Revised to measure spontaneity. 3) Background on how the study aimed to provide evidence for psychodrama's ability to increase spontaneity and

1. 2021 Online Group Psychotherapy &Psychodrama Conference
American Society of Group Psychotherapy & Psychodrama
April 7-11, 2021
“From anxiety
through psychodrama
to spontaneity”
Galabina Tarashoeva, MD, PhD,
Petra Marinova – Djambazova, MD, PhD
Psychodrama Center & Psychiatric Practice Orpheus
Medical University Sofia, department of Psychiatry
Sofia, Bulgaria,
orpheuspsychodrama@gmail.com
Membership: IAGP, FEPTO, BSPGT, BAP, BMU

2. I dedicate the results of this study
(Effectiveness of psychodrama in the treatment of Panic Disorder)
to the memory of Professor David Kipper
from the University of Chicago,
who not only dared to measure spontaneity
but contributed greatly psychodrama to become science!

3. David Kipper in Orpheus
October 1993 – the
opening of Orpheus
October 1996

4. David Kipper in Orpheus
Jully 1999 January 2001

5. David Kipper in Orpheus
August 2004 July 2007

6. Content:
* Genesis of this research
- The reasons
- The history
* Design of the research
* Characteristics of the patients
* Instruments for measuring
* Results and Conclusions
* Additional tasks
* Contributions
* Acknowledgements

7. Genesis of this
research:
The reasons

8. - Why panic disorder (PD)?
- we owe it to our patients!
 PD prevalence among the population is high - from 1%
to 4% (Pompoli 2016),
 20-40% of all patients with PD fail to respond adequately
to the initial treatment (Bystritsky, 2006),
 Despite the presence of pharmacotherapy, psychotherapy
and combined therapy, 1/3 of all patients with PD have
persistent panic attacks and other symptoms of PD even
after treatment (Freire 2016).
 This requires enrichment of the therapeutic
repertoire with new, proven, effective methods of
therapy of PD

9. - Why Psychodrama?
- we owe it to our method!
About the need for more scientific
evidence to validate the psychodrama
method, call
professor David Kipper, (Kipper, 1978)
 Peter Felix Kellermann (Kellermann, 1987) and
Michael Wieser, (Wieser, 2007)
 in which we are also convinced.
,,

10. - Why Psychodrama?
 Spontaneity is disturbed in all mental disorders, and the
lack of spontaneity is anxiety (Moreno & Moreno, 1975).
 The effectiveness of Psychodrama to increase spontaneity
was scientifically proven in non-clinical sample - women,
victims of violence (Testoni et al., 2012, 2013а, 2013b), students with test
anxiety, (Kipper & Giladi, 1978), pupils(Orkibi et al., 2017)
 Patients with Panic Disorder have a higher rate of
inhibition of behavior than controls (Reznick, et. al., 1992).
 This gave us the reason to hypothesize that
psychodrama, increasing the spontaneity of patients
with Panic Disorder will reduce their anxiety.

11. In accessible for us literature, no study of
effectiveness of psychodrama psychotherapy
at Panic Disorder has been published.
• Evidences that Panic Disorder is well-influenced by
various psychotherapeutic methods, of which CBT has
the most evidence (Pompoli et al., 2016), but there is also
evidence of psychodynamic therapy (panic-focused
psychodynamic psychotherapy (Beutel ME , et al., 2013) gave us
reason to assume that psychodrama psychotherapy also
will be an effective method for its treatment.
• The effectiveness of the psychodrama method as an
addition to pharmacotherapy has been demonstrated in
some other mental illnesses such as Major Depressive
Disorder (Costa et al., 2006), which may give us reason to assume
good effectiveness in addition to pharmacotherapy for
Panic Disorder .

12. Genesis of this research
-the history
• Group for
European
Research
Projects
In FEPTO RC

13. Edinburgh – 2009 FEPTO Research Committee meeting –
training seminar led by prof. Robert Elliot –
Practice Based Research of the Efficiency of Psychotherapy and
Psychotherapy Training: research framework and protocols
• R. Elliott focused towards the
need to promote psychodrama
within other scientific proven
psychotherapies.
• Even this is a very ambitious
goal which requires a high
quality research (based on
randomized control trials), our
group decided to try such an
application aiming for a
research on the effectiveness
of psychodrama in clinical
settings.
• The GfERP was founded
during the meeting

14. In Taormina - 2009
• The motivation for the
project (COST) aiming a
research on the
effectiveness of
psychodrama in clinical
settings, was for high
profile research because
psychodrama lacks such
research.
• The group decided on the
research design,
• One of the project’s aims
was to translate and
validate the SAI-R
(Spontaneity Inventory) in
all participating countries

15. In Boldern 2010 – COST project:
• Good research design, but the
main obstacle is FUNDING,
because COST does NOT
finance research itself
• An alternative is to begin with a
pilot project with one
psychodrama group (10 people
experimental group, 10 in control
group in 5 countries: Austria,
Sweden, Italy, Bulgaria,
Romania)

16. Lisbon 2010 - International Summer School for
Psychotherapy and Counseling Research,
At the open panel discussion group with
John McLeod, Chris Evans, Rene
Marineau we presented A research
design of “The effectiveness of
psychodrama in treating anxiety
disorders”
Creating detailed design
for pilot research in Orpheus with
support of
• Professor Célia Sales, M.D.,
Universidade de Évora, Portugal, and
• Professor Chris Evans, M.D., London,
England

17. Isle of Man 2011
• We came to the
conclusion that we will
start with explanatory
case studies to find a
model how to work with
psychodrama in this
field. We will use SAI-R
because spontaneity is
considered to be an
antagonist of anxiety.

18. Implementation of the pilot research
in Bulgaria
• Psychodrama became a popular method for psychological
treatment in Bulgaria.
• However, there is no scientific evidence of its effectiveness in
Bulgaria.
• In this study, for the first time we study the effectiveness of
psychodrama method in a Bulgarian sample
• The research was directed by department of Psychiatry and
medical psychology in Medical University “Prof. Parashkev
Stoyanov” Varna.
• The groups were conducted in the City Mental Health Centre
“Prof. N. Shipkovensky”, Sofia,
• The patient were from Mental Health Centre “Prof. N.
Shipkovensky”, and from some outpatients practices

19. Design of the research
“Some aspects of
Effectiveness of
psychodrama in
the therapy of
panic disorder”

20. Goal :
To answer the research question:
Is psychodrama an effective method in the treatment of
patients with panic disorder according the definition of
DSM-IV-TR
Method:
Open randomized prospective pilot interventional clinical
research with control group
Hypothesis:
In patients with panic disorder parallel treatment with
psychodrama therapy and pharmacotherapy is more
effective than pharmacotherapy alone.

21. Strategy:
To compare the reduction of symptoms and the
change in the quality of life in patients with panic
disorder before and after parallel treatment with
psychodrama and pharmacotherapy versus
pharmacotherapy alone.

22. Design of the research:
Distribution of the patients in 2 groups – psychodrama group and
control group, with stratification for demographic parameters,
Illness characteristics and baseline of spontaneity and anxiety.
• Each patient in the psychodrama group as well as in the control group
receives hisher pharmacotherapy and regular visits to their own
psychiatrist.
2 psychodrama groups with patients with panic disorder were
directed successively in Mental Health Center „Prof. N.
Shipkovensky“
• In parallel with each psychodrama group there was a control group with
the same number of patients – 9-11, with panic disorder receiving only
pharmacotherapy.

23. Design of the research:
Psychodrama groups were directed by team of 2 certified
psychodrama therapists.
Each of the first groups (psychodrama and control) has 9
patients with panic disorder , each of the second groups - 11
and psychodrama groups worked for 6 months: 25 group sessions
(3 hours each) weekly.

24. Evaluation:
1. before including
in the research
2. after the end of
the period of
group therapy
3. follow up 6
months after the
end of the period
of group therapy
For evaluation of the
heaviness of the
disorder
Hamilton for anxiety
For measuring the
change in symptoms,
quality of life and
social functioning:
CORE‐OM - Clinical
Outcomes in Routine
Evaluation
(Chris Evans)
SAI‐R – Spontaneity
Assessment
Inventory
(David Kipper)
For diagnostics of the patients:
hemi-structured interview, done by clinicians
according to the diagnostic criteria of DSM-IV-TR)

25. Tasks:
To follow and compare:
 decrease in anxiety
(measured by HAM-A)
 improvement of mental
well-being, general
clinical outcome,
problems / symptoms,
risk to himself and others
and functioning
(measured by CORE-
OM)
 the change in the
spontaneity (measured
by SAI-R)
 To measure the keeping
the achieved changes 6
months after the end of
the course.
 To assess the correlation
between changes in:
 spontaneity and anxiety,
as well
 spontaneity and mental
well-being

26. Additional tasks:
To follow, describe and analyze, as far as
possible, in content:
 the topics for personal work in the groups,
 the subjects and problems under this topics:
unsatisfied basic needs during childhood,
 child traumas,
 personal characteristics.
This information we received only during
working in psychodrama groups, so we
don’t have such information about groups
with controls.

27. Characteristics
of
the Patients:

28. Demographic parameters:
Psychodrama Controls Significance
(Stat. test)
Average age 43.7 years
(SD 9.65)
(min 25, max 59)
42.85 years
(SD 11.37)
(min 22, max 60)
p = 0.80
(t test)
Gender 85% females
(17 female and 3 male)
65% females
(13 female and 7 male)
p = 0.273
(Fisher test)
Educational
level
University: n = 11
High school: n = 9
Primary school: n = 0
University: n = 10
High school: n = 9
Primary school: n = 1
p = 0.53
(Chi square)
Partnership
Status
Single: n = 6
Living with partner: n = 13
In a relationship: n = 1
Single: n = 8
Living with partner: n = 12
In a relationship: n = 0
p = 0.52
(Chi square)

29. Illness characteristics:
Psychodrama Controls Significance
(Stat. test)
Average Duration
of illness
(in years)
7.7 (SD 7.58) 7.58 (SD 6.44) p = 0.95 (t test)
Average Duration
of episode
(in months)
10.7 (SD 12.95) 11.0 (SD 12.43) p = 0.94 (t test)
Average Duration
of
Pharmacotherapy
(in months)
8.4 (SD 12.82) 8.7 (SD 12.43) p = 0.94 (t test)

30. Groups duration:
• The first psychodrama
group took place from
17.11.14 to 17.05.15
• The follow up of the
patient from the
psychodrama group and
from the control group –
after 17.11.15
• The second psychodrama
group took place from
27.05.15 to 09.12.15
• The follow up of the
patient from the
psychodrama group and
from the control group –
after 09.06.16

31. Instruments
for
Measuring :

32. SPONTANEITY
AND ITS
MEASURING:
SAI–R

33. Spontaneity in the colloquial
meaning:
 a quick response - “sudden”, “impulsive”
 Uninhibited response - “without restraint”,
unconstrained emotional expression
 Contains both positive and negative connotations:
 (+) - honesty and openness
 (-) - uncontrolled acting out with disregard to personal
and social boundaries

34. Spontaneity In The Context of
Psychodrama (Moreno, 1944):
 central theoretical clinical concept
 invisible energy that propels the individual towards a
“new response to an old situation or adequate
response to a new situation”
a skill -“The spontaneity can be trained and, in fact,
training clients to become spontaneous has been a
fundamental goal of the psychodrama treatment”
(Blatner, 2000; Kipper, 1986).

35. Moreno
• Spontaneity evolutionary is the oldest, older than libido,
memory or intelligence, but it is easier discouraged
and restricted by cultural norms
• Spontaneity is (or is not) available in varying degrees of
readiness, from zero to maximum, it works as a catalyst.
• Spontaneity only works at the moment of appearance,
it can not be stored
• Its quantity must be in accordance with the requirements
of the situation or the task - no more or less.

36. Spontaneity – conceptualized by
David Kipper:
An experiential state of mind rather than either energy
or a skill.
Sing of good mental health
Measure for therapeutic progress
Studies showed: spontaneity cannot coexist in parallel
with a state of anxiety
 positive correlations between a measure of spontaneity
and well-being, self-efficacy, and self-esteem and
 negative correlations between spontaneity and anxiety,
stress, and obsessive-compulsive tendencies
(Christoforou& Kipper, 2006; Kipper et al., 2008; Kipper et al., 2009).

37. Psychometrically valid Measuring the
Spontaneity:
an action-based spontaneity test - Moreno (1944) -
examined the spontaneous reaction of one individual
to another against him
Spontaneity Assessment Inventory (SAI) designed by
Kipper and Hundal (2005)
Revised Spontaneity Assessment Inventory
(SAI-R: Kipper & Shemer, 2006)

38. SAI - R
 18 items,
 self-reported inventory,
 designed to measure the intensity of
feelings and thoughts that characterize
the state of mind described as
spontaneity.
 “How strongly do you have these
feelings and thoughts during a
typical day?”
The amount:
• under 69 = low spontaneity
• 72 – 83 = optimal spontaneity
• over 83 = high spontaneity
 Spontanaity’s quantity must be in
accordance with the requirements of
the situation or the task - no more or
less.(Moreno)

39. ANXIETY
AND ITS
MEASURING:
HAM - A

40. Moreno about Anxiety:
❖Anxiety is a result of a "loss" of spontaneity
❖Anxiety occurs because there is no spontaneity, not
because "there is anxiety“.
❖If the answer to the current situation is adequate -
there is "completeness" of spontaneity - the anxiety
decreases and disappears.
❖With decreasing spontaneity (the adequacy of the
response) anxiety increases
❖With total loss of spontaneity, anxiety reaches its
maximum - panic.
 Spontaneity is disturbed in all mental disorders, and the
lack of spontaneity is anxiety (Moreno & Moreno, 1975).

41. Moreno about spontaneity and
anxiety
Spontaneity and anxiety
may exist
within the same person,
but not at the same time
or within the same situation
(Moreno, 1964)

42. Hamilton Anxiety Rating
Scale (HAM-A)
Rating Clinician-rated
Administration time 10–15
minutes
Main purpose To assess the
severity of symptoms of
anxiety
14 items, each defined by a
series of symptoms,
measures both:
- psychic anxiety (mental
agitation and psychological
distress) and
somatic anxiety (physical
complaints related to
anxiety).
total score range of 0–56, where
<17 indicates mild severity,
18–24 mild to moderate severity and
25–30 moderate to severe.
Reference: Hamilton M.The assessment of anxiety states
by rating. Br J Med Psychol 1959; 32:50–55

43. Clinical
Outcomes
in
Routine
Evaluation –
CORE‐OM

44. CORE OM – questioner for
Clinical Outcomes in Routine Evaluation – Outcome Measure
(Chris Evans et al., 2000)
In Bulgarian, it is validated
in parallel with the
Spontaneity Test
(SAI R) in the course
of the European Research
Project EMPOWER,
led by the
University of Padua, Italy,
with our participation.
(Testoni et al., 2012, 2013а, 2013b).
CORE‐OM

45. CORE OM - Chris Evans
Clinical Outcomes in Routine Evaluation – Outcome
Measure (Evans et al., 2000)
• Designed to “help bridge the gap between research and
practice”:
 Short
 User Friendly (client and therapist)
 Useful
 “Copyleft”
(Evans, 2003)

46. CORE OM
• Self report measure
• 34 items covering four dimensions:
1. subjective well‐ being (4 items)
2. problems/symptoms (12 items)
3. life/social functioning (12 items)
4. risk/harm to self and to others (6 items).
• The measure is problem scored= the higher the score the
more problems the individual is reporting and/or the more
distressed they are.

47. The Results
and
Conclusions:

48. Conclusion 1
In patients with Panic
disorder psychodrama
therapy:
 is effective in
reducing anxiety,
 It reduces anxiety
below those taken
for pathological
level in over 50% of
patients.
 This reduction
remains significant
6 months after
completion of the
psychodrama
treatment course.
With comparable baseline score for anxiety
in the psychodrama group and the control
group, in the group, treated additionally
with psychodrama for 6 months, anxiety
symptoms are significantly decreased in
comparison with those treated only with
standard pharmacotherapy.
Improvement in Anxiety with
Psychodrama

49. Reduction of anxiety
• With an average of anxiety level above score 30 (=heavy
anxiety), the level of anxiety for the psychodrama group
at the end of the therapy is practically below those
assumed for pathological, (score 14 ) in 55% of patients,
and in 60% of patients in 6 months follow up.
• Newburger in a naturalistic, with 7-month follow-up
research of effectiveness of psychodrama for phobias, reported
that all 10 patients at the end of treatment were symptom-free
and eight of them were asymptomatic even after 7 months of
follow-up, and without anxiety as one of the main symptoms
of this disorder
• (Newburger, 1987).

50. Conclusion 2
This result
convincingly
demonstrates that
psychodrama
therapy is effective
in increasing
spontaneity in
patients with panic
disorder.
With comparable baseline score for
the psychodrama group and the
control group, in the groups, treated
additionally with psychodrama,
spontaneity is significantly
increased.
This increase remains significant 6
months after completion of the
treatment course
Improvement in Spontaneity with
Psychodrama:

51. Improvement in Spontaneity
• The average baseline score of spontaneity, both in the
psychodrama group (51.25) and in the control group
(48.65), corresponds to a low spontaneity of less than 69
• This confirms Moreno's thesis of blocked spontaneity in the
presence of anxiety (Moreno, 1964),
• and corresponds to data that patients with PD have a
higher rate of inhibition of behavior than controls (Reznick et
al., 1992).
• It can be explained by the blocked spontaneity in these
individuals, which begins in childhood, manifests itself in
caution, timidity, shyness and introvertness, increases over
the years and reaches its maximum when panic attacks
begin.
• This manifests itself in the protagonists personal work
of patients in psychodramatic sessions during our study.

52. Improvement in Spontaneity
• Despite the significant increase in spontaneity in
patients with psychodrama and reaching 61.3, it
remained below optimal spontaneity of healthy
individuals - 72-83.
• Our result confirms in a clinical sample what found
in the EMPOWER study that the measured spontaneity
levels of women, victims of domestic violence, are lower
than the normal population both before (49.65) and after
psychodramatic interventions (54,71), although
significant improvements have been reported following
these interventions (Testoni et al., 2012, 2013a, 2013b).

53. Spontaneity and anxiety
• Our study showed that in 55% of the patients,
anxiety can be overcome, while spontaneity,
although rising, can not reach “healthy level" for the
same period in which anxiety “become health".
• Whether this means that the disorder of spontaneity
is the older and deeper disorder, more difficult to
overcome, and anxiety is just one of its current
manifestations, more easily removable, is only one
possible hypothesis.
• “Spontaneity evolutionary is the oldest, older than libido,
memory or intelligence, but it is easier discouraged and
restricted by cultural norms”(Moreno)

54. Spontaneity and Anxiety in psychodrama
groups and in control groups
34.25
13.2
10.9
33.45
25.75 25.15
51.25
61.3 60.65
0
10
20
30
40
50
60
70
Baseline 6th month Follow-up
HAM-A
score
HAM-A
Psychodrama
HAM-A Controls
SAI-R Psychodrama
SAI-R Controls

55. Conclusion 3
Our research
convincingly
shows that with
the increase in
spontaneity in
patients with
panic disorder,
anxiety is
reduced.
Spontaneity and anxiety in panic disorder
Correlation between differences of SAI R
and HAM A
There is a significant correlation between
the changes in spontaneity and anxiety
scores for all subjects as a whole (R = -
0.645) and a statistically significant (p
<0.001) negative correlation

56. Conclusion 4
This result
convincingly
demonstrates
that
psychodrama
therapy is
effective in
improving
overall clinical
outcomes in
patients with
PD.
With comparable baseline score for the
psychodrama group and the control group , in
the group, treated additionally with psychodrama,
outcome measures are significantly improved in
comparison with those treated only with standard
pharmacotherapy. This improvement remains
significant 6 months after completion of the
psychodrama treatment course
Improvement of the Outcome CORE OM all
With psychodrama:

57. Conclusion 5
 Psychodrama
therapy is an
effective in
increasing
subjective
wellbeing in
patients with Panic
Disorder
 Our results fully
confirm the results of
Prof. David Kipper,
proving a positive
correlation between
spontaneity and
wellbeing, and a
negative correlation
between spontaneity
and anxiety.
Improvement in Wellbeing with
Psychodrama:
With comparable baseline score for the
psychodrama group and the control group,
in the group, treated additionally with
psychodrama for 6 months, wellbeing is
significantly improved in comparison with
those treated only with standard
pharmacotherapy.
This improvement remains significant 6 months
after completion of the psychodrama therapy.

58. Conclusion 6
Our research
convincingly shows
that with the
increasing in
spontaneity in
patients with panic
disorder, subjective
wellbeing is
increasing
This result of our
study supports
Moreno's thesis that
there is a positive
correlation between
spontaneity and
mental health
Correlation between SAI R and
CORE OM-W
A strong (R> 0.7), negative and
statistically significant
(p <0.001) correlation relationship
of the Spontaneity Indicator SAI R
and the Mental Wellbeing
CORE OM-W

59. Conclusion 7
This result
convincingly
demonstrates
that
psychodrama
therapy is an
effective in
reducing
problems /
symptoms in
patients with
PD
With comparable baseline score for the
psychodrama group and the control group, in the
group with psychodrama after the end of the
therapy, the improvement in the problems was
significantly greater than those treated with
standard pharmacotherapy alone.
This improvement was maintained significantly
6 months after the end of the psychodrama
treatment course
Reduction of problems / symptoms with
psychodrama:

60. Conclusion 8
This result
demonstrates that
psychodrama
therapy is effective
in terms of longer-
term risk
reduction for
themselves and
others in patients
with PD.
With comparable starting score for the
risk to self and the others in the
psychodrama and control group, there
is a gradual improvement in risk for
both groups. There is a greater but not
significant improvement in the groups
treated with psychodrama.
The difference in improvement
reached statistical significance at the
evaluation 6 months after the end of
the psychodrama therapy
Improving the risk for self and others
with psychodrama:

61. Social
functioning:
Because of the
baseline significant
difference in social
functioning, an
ANCOVA analysis was
performed including the
covariant CORE-OM-
F1.
The analysis showed
that the initial difference
in CORE-OM-F between
the two groups did not
have a significant effect
on the results for
HAM-A and SAI-R
Improvement of social functioning
was achieved both in the
psychodrama group and in the
control group
Social functioning :

62. Additional tasks
To follow,
describe and
analyze,
as far as possible,
in the content:

63. Topics of protagonist‘s work -
personal loss events
 Events of: death of a close person (5), loss of work
(3), problem relationships in the closest circle (8 + 2 +
1 = 11), coincide with the occurrence of panic disorder
in almost all (19 out of 20 participants).
This result is consistent with another study, indicating
that personal loss events coincided with the occurrence of
panic disorder in more than half of patients
(Milrod et al., 2004, Klass, et al., 2009)
 anxiety, uncertainty, timidity, inferiority in school
age, isolation, ignorance, mockery by classmates

64. Unsatisfied basic needs in
childhood:
lack of love - 12 participants,
 lack of security and protection - in 12
participants,
 lack of appreciation and liking - in 13
participants,
with eight participants experiencing all three
deficits
patients report significant stressors, prior to
the onset of panic, that are usually associated
with childhood experience and are a threat to
attachment.
(Milrod et al., 1997)

65. Characteristics of the parents of PD
patients:
4 participants share about a violent parent,
3 – for an over-demanding and over-
controlling parent,
one - for rejecting and neglecting two
parents.
This result supports Milrod's findings for
characteristics of parents of patients with PD-
whimsical, critical, frightening, demanding and
controlling.
(Milrod et al., 1997).

66. Dealing with the anger
In 16 participants in their protagonist’s work
revealed:
blocked, unexpressed anger,
humiliation by an over-controlling or brutally
rejecting father,
deeply suppressed shame and pain,
over-demanding over-ambitious mother,
fear of expression of anger
These patients also share the difficulty of recognizing
and expressing angry feelings (Milrod et al., 1997)

67. Personal characteristics, they
want to release:
 12 participants identify themselves with the
sacrifice characteristic - "others are more important
than me", "I love giving, but I can not get"
 14 participants - inability for assertiveness, and
 4 shared that they had it before
Patients with panic disorder have a higher rate of
inhibition of behavior than controls
(Reznick, et. al., 1992),
• … as well as shame and vulnerability to
disability or illness and readiness for self-
sacrifice
(Kwak, et al., 2015, Kagan, et al., 1984).

68. Contributions:

69. Theoretical Contributions:
It was first time proved in
patients with PD:
• that psychodrama is an
effective therapeutic
method for reducing
anxiety and increasing
well-being, reducing the
problem/symptoms , risk
for themselves and others,
and improving the overall
clinical outcome
• the effectiveness of
psychodrama as a method
of enhancing spontaneity
Confirmed in a clinical
sample, non-clinical data:
• the negative
correlation between
spontaneity and
anxiety
• positive correlations
between spontaneity
and mental well-being
• negative correlation
between SAI-R and
CORE-OM

70. Practical contributions:
• It is provided yet
another effective
therapeutic approach
to the therapies for
one of the most
common psychiatric
disorders with a
chronic course and a
high risk of
disability - the
psychodrama
method.
• The diagnostic tool in
the psychiatric practice
in Bulgaria is enriched
with the
popularization of two
previously validated
tests - Prof. David
Kipper - SAI-R
spontaneity test and
Chris Evans' general
clinical test - CORE-
OM.

71. Future development opportunities:
• Study of the therapeutic factors and the
therapeutic process in psychodrama
therapy in patients with PD.
• Investigation of the risk factors for
development of the PD - personality profile
of patients with PD, the most common topics
in the protagonist centered personal work,
the type of early childhood trauma and it’s
recurrent no adaptable models.
• Developing and approbating a manual to
prevent PD by supporting personality
development, and psychodrama
psychotherapy with a PD already existed.

72. Conclusions:
• It was proofed that the benefits of parallel therapy with
psychodrama and pharmacotherapy for panic disorder
are:
• a significantly higher improvement in anxiety
symptoms than treatment with pharmacotherapy only,
• as for a 6-month treatment course, 55% of patients
reached a complete lack of clinically significant anxiety
symptoms.
• and this improvement correlates with a significant
increase in their spontaneity and improvement of their
wellbeing and general clinical outcome.
• The improvement achieved remains significant 6
months after the completion of the psychodrama
treatment course.

73. Acknowledgements I thank all those who have
contributed to the creation and the success of this study:
- The team of the Research Committee at FEPTO, with coordinator Gabriela Moita University
of Porto, and in particular the European Projects Group - Gabriela Dima, Spiru Haret
University of Brasov, Michaela Bucuta, University of Sibiu, Romania, Prof. Michael
Wieser, Alpen Adria University of Klagenfurt, Austria, Maria Silvia Guglielmin
University of Padua, created the original idea of designing a European Psychodrama
Efficacy Study for Anxiety Disorder (unrealized), which has grown into the idea of pilot
studies in individual countries.
- Prof. Chris Evans, MD, University of Cambridge, CORE System Trust, and Prof. Celia
Sales, University of Porto, which helped me to refine the design idea of the study.
- Prof. Ines Testoni, University of Padova and the entire international team of the European
project EMPOWER, incl. Maria Gorinova and Teodora Nikolova, from Orpheus,
Bulgaria, through which the SAI-R and CORE-OM tests in Bulgaria were validated
- Angel Tomov and Rayna Nemtsova as co-leaders of the psychotherapeutic groups, Dr.
Maya Kostadinova, who has administered HAM-A
- All patients, participated in the study
- Petra Marinova for the constant support, knowledge and experience
- All colleagues, who referral patients for participation in the study
- Prof. Kojuharov, Prof. Shishkov, and the entire Department of Psychiatry and
Medical Psychology at the University of Medicine in Varna to provide opportunities for
the realization of the ideas and their popularization in the Bulgarian academic psychiatric
community, as well as for the cooperation, support and understanding.

74. THANK YOU,
PSYCHODRAMA

75. Questions?
Thank you for your attention!
orpheuspsychodrama@gmail.com
www.Tarashoeva.com